Calculation of transonic steady and oscillatory pressures on a low aspect ratio model and comparison with experiment

Pressure data measured by the British Royal Aircraft Establishment for the AGARD SMP tailplane are compared with results calculated using the transonic small perturbation code XTRAN3S. A brief description of the analysis is given and a recently developed finite difference grid is described. Results are presented for five steady and nine harmonically oscillating cases near zero angle of attack and for a range of subsonic and transonic Mach numbers

Guest Editors' introduction: philosophical contributions to leadership ethics

This article introduces the first of two special issues on philosophical approaches to leadership ethics. In it, we show some of the ways that philosophy contributes to the study of leadership and leadership ethics. We begin with an overview of how philosophers have treated some of the ethical aspects and challenges of leadership. These include discussions of self interest, the problem of dirty hands, responsibility, moral luck, power, gender and diversity, and spirituality. The articles in this issue draw on philosophy to explore a variety of ethical questions related to leadership and the relationships that leaders have with followers and others

Support and performance improvement for primary health care workers in low- and middle-income countries: a scoping review of intervention design and methods.

Primary health care workers (HCWs) in low- and middle-income settings (LMIC) often work in challenging conditions in remote, rural areas, in isolation from the rest of the health system and particularly specialist care. Much attention has been given to implementation of interventions to support quality and performance improvement for workers in such settings. However, little is known about the design of such initiatives and which approaches predominate, let alone those that are most effective. We aimed for a broad understanding of what distinguishes different approaches to primary HCW support and performance improvement and to clarify the existing evidence as well as gaps in evidence in order to inform decision-making and design of programs intended to support and improve the performance of health workers in these settings. We systematically searched the literature for articles addressing this topic, and undertook a comparative review to document the principal approaches to performance and quality improvement for primary HCWs in LMIC settings. We identified 40 eligible papers reporting on interventions that we categorized into five different approaches: (1) supervision and supportive supervision; (2) mentoring; (3) tools and aids; (4) quality improvement methods, and (5) coaching. The variety of study designs and quality/performance indicators precluded a formal quantitative data synthesis. The most extensive literature was on supervision, but there was little clarity on what defines the most effective approach to the supervision activities themselves, let alone the design and implementation of supervision programs. The mentoring literature was limited, and largely focused on clinical skills building and educational strategies. Further research on how best to incorporate mentorship into pre-service clinical training, while maintaining its function within the routine health system, is needed. There is insufficient evidence to draw conclusions about coaching in this setting, however a review of the corporate and the business school literature is warranted to identify transferrable approaches. A substantial literature exists on tools, but significant variation in approaches makes comparison challenging. We found examples of effective individual projects and designs in specific settings, but there was a lack of comparative research on tools across approaches or across settings, and no systematic analysis within specific approaches to provide evidence with clear generalizability. Future research should prioritize comparative intervention trials to establish clear global standards for performance and quality improvement initiatives. Such standards will be critical to creating and sustaining a well-functioning health workforce and for global initiatives such as universal health coverage

Development of an Innovative Mobile Phone-Based Newborn Care Training Application

Mobile infrastructure in low - and middle-income countries (LMIC) has shown immense potential to reach the unreachable. Healthcare providers (HCP) are one such group who are at the frontline of the fight against infant mortality in LMICs. Mortality among newborn infants (birth to 28 days) now accounts for around 45% of all under 5-years child mortality. Birth asphyxia is one of the three leading causes of newborn death; neonatal resuscitation training, among health care providers, reduces mortality from birth asphyxia. We have developed a mobile phone-based training app, called mobile Helping Babies Survive (mHBS), to support the training of health care providers on neonatal resuscitation. mHBS is integrated with the District Health Information System (DHIS2) platform, which is used in over 60 countries around the world. The mHBS/DHIS2 training app is a part of an application suite which includes another DHIS2-linked data collection app, mHBS tracker. The mHBS training application has the potential to scale-up integration with other neonatal training apps. Ultimately, the mHBS training suite will provide new insights into healthcare worker education along with the necessary tools for effective care of newborn babies

Spatial clustering of high load ocular Chlamydia trachomatis infection in trachoma: A cross-sectional population-based study

Chlamydia trachomatis (Ct) is the most common cause of bacterial sexually transmitted infection and infectious cause of blindness (trachoma) worldwide. Understanding the spatial distribution of Ct infection may enable us to identify populations at risk and improve our understanding of Ct transmission. In this study, we sought to investigate the spatial distribution of Ct infection and the clinical features associated with high Ct load in trachoma-endemic communities on the Bijagós Archipelago (Guinea Bissau). We collected 1507 conjunctival samples and corresponding detailed clinical data during a cross-sectional population-based geospatially representative trachoma survey. We used droplet digital PCR to estimate Ct load on conjunctival swabs. Geostatistical tools were used to investigate clustering of ocular Ct infections. Spatial clusters (independent of age and gender) of individuals with high Ct loads were identified using local indicators of spatial association. We did not detect clustering of individuals with low load infections. These data suggest that infections with high bacterial load may be important in Ct transmission. These geospatial tools may be useful in the study of ocular Ct transmission dynamics and as part of trachoma surveillance post-treatment, to identify clusters of infection and thresholds of Ct load that may be important foci of re-emergent infection in communities

Making sense of variety in place leadership: the case of England’s smart cities

Making sense of variety in place leadership: the case of England’s smart cities. Regional Studies. There is rising interest in cities becoming ‘smart’ knowledge-oriented economies by prioritizing more digitally enabled modes of production and service delivery. Whilst the prevalence of these new organizational forms is well understood, the way that leadership agency is exercised (i.e., the actors involved and their modalities of action) is not. Drawing on new empirical data and sense-making methodology, the paper reveals discursive patterns in how public agencies, private firms and communities ‘see’ and ‘do’ leadership within these place-based contexts, and concludes that success in exploiting the social and spatial dynamics of ‘smart’ development lies in understanding actors’ assumptions about commercial and social gain

Integrated care as a means to improve primary care delivery for adults and adolescents in the developing world: a critical analysis of Integrated Management of Adolescent and Adult Illness (IMAI)

Background: More than three decades after the 1978 Declaration of Alma-Ata enshrined the goal of ‘health for all’, high-quality primary care services remain undelivered to the great majority of the world’s poor. This failure to effectively reach the most vulnerable populations has been, in part, a failure to develop and implement appropriate and effective primary care delivery models. This paper examines a root cause of these failures, namely that the inability to achieve clear and practical consensus around the scope and aims of primary care may be contributing to ongoing operational inertia. The present work also examines integrated models of care as a strategy to move beyond conceptual dissonance in primary care and toward implementation. Finally, this paper examines the strengths and weaknesses of a particular model, the World Health Organization’s Integrated Management of Adolescent and Adult Illness (IMAI), and its potential as a guidepost toward improving the quality of primary care delivery in poor settings. Discussion Integration and integrated care may be an important approach in establishing a new paradigm of primary care delivery, though overall, current evidence is mixed. However, a number of successful specific examples illustrate the potential for clinical and service integration to positively impact patient care in primary care settings. One example deserving of further examination is the IMAI, developed by the World Health Organization as an operational model that integrates discrete vertical interventions into a comprehensive delivery system encompassing triage and screening, basic acute and chronic disease care, basic prevention and treatment services, and follow-up and referral guidelines. IMAI is an integrated model delivered at a single point-of-care using a standard approach to each patient based on the universal patient history and physical examination. The evidence base on IMAI is currently weak, but whether or not IMAI itself ultimately proves useful in advancing primary care delivery, it is these principles that should serve as the basis for developing a standard of integrated primary care delivery for adults and adolescents that can serve as the foundation for ongoing quality improvement. Summary As integrated primary care is the standard of care in the developed world, so too must we move toward implementing integrated models of primary care delivery in poorer settings. Models such as IMAI are an important first step in this evolution. A robust and sustained commitment to innovation, research and quality improvement will be required if integrated primary care delivery is to become a reality in developing world